Chondroitin sulfate is a popular dietary supplement for osteoarthritis (OA) that often is used in combination with glucosamine, but questions remain as to whether it is effective for the long-term management of knee OA or whether it has an impact on disease outcome.

A 2-year study using quantitative magnetic resonance imaging (qMRI) found that not only was chondroitin sulfate effective, it outperformed the COX-2 selective nonsteroidal anti-inflammatory agent celecoxib (Celebrex, other), according to the results of a study presented at the American College of Rheumatology’s 2015 annual meeting.1

In the study, patients received either high-dose chondroitin sulfate (1,200 mg/d) or celecoxib (200 mg/d) and underwent MRI at baseline and then at 12 and 24 months. The investigators measured cartilage volume loss, bone marrow lesion (BML) size, and synovial membrane thickness using qMRI and evaluated the presence of joint swelling and effusion.

Clinical symptoms were evaluated using validated questionnaires. They also performed statistical analyses on the intention-to-treat (ITT) population (n=194 patients), the per protocol set (n= 195) and the according-to-protocol completer population (n=120).

The study found that compared to celecoxib patients (n=97), chondroitin sulfate patients (n=97) had less cartilage volume loss at 12 months (P=0.017) and 24 months (P =0.013) in the medial tibiofemoral compartment, reported lead investigator Jean-Pierre Pelletier, MD, from the department of rheumatology, Institut de Recherche en Rhumatologie de Montréal (IRRM), Montréal, Canada.

Cartilage volume loss of the global knee also was reduced at 12 months (P = 0.034) and 24 months (P = 0.054). There were no differences in synovial thickness or bone marrow lesion size between the two treatment groups over the study period. There was a marked reduction in the incidence of joint swelling plus effusion in both the chondroitin (51%, 59 vs. 6 patients) and celecoxib (39%, 55 vs. 11 patients) groups from baseline to 24 months.

However, celecoxib appeared better at reducing pain, achieving a reduction in Visual Analog Pain scores of 55% at 24 months, compared to 48% for chondroitin sulfate. The use of rescue analgesic (acetaminophen) was not significantly different between the chondroitin sulfate and celecoxib groups (584 vs. 472 mg/d, respectively).

Celecoxib slightly outperformed chondroitin sulfate on The Western Ontario and McMaster Universities Arthritis Index (WOMAC) scale. The celecoxib group had a 54% reduction in WOMAC scores at 24 months, compared to chondroitin sulfate’s 43% reduction. Incidence of adverse events was also similar between the treatment groups.

“This trial demonstrated, for the first time, the superiority of chondroitin sulfate over celecoxib at reducing the long-term progression of knee OA structural changes,” wrote the investigators. “Moreover, both drugs were found equally effective at reducing the symptoms of OA. These findings have important implications regarding the usefulness of chondroitin sulfate for long-term management of knee OA and its impact on disease outcome.”

In a separate study of the combination chondroitin sulfate and glucosamine, investigators found that the combination (400 mg/d chondroitin plus 200 mg/d glucosamine) was comparable to celecoxib (200 mg/d) in reducing pain in patients with knee OA.2

“This fixed-dose combination should offer a safe and effective alternative for those patients with cardiovascular or gastrointestinal conditions who have contraindications to celecoxib,” reported Marc Hockberg, MD, of the University of Maryland School of Medicine, in Baltimore. Note that the dose of chondroitin used in the combination study was one-third that of the MRI study.

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